1821382870 NPI number — ASIAN AMERICAN CHEMICAL DEPENDENCY TREATMENT SERVICES

Table of content: (NPI 1821382870)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821382870 NPI number — ASIAN AMERICAN CHEMICAL DEPENDENCY TREATMENT SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASIAN AMERICAN CHEMICAL DEPENDENCY TREATMENT SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ASIAN COUNSELING TREATMENT SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821382870
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/16/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9100 BRIDGEPORT WAY SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98499-2427
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-302-3826
Provider Business Mailing Address Fax Number:
253-267-5212

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4629 168TH ST SW STE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LYNNWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98037-8640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-776-1290
Provider Business Practice Location Address Fax Number:
425-776-1298
Provider Enumeration Date:
06/07/2011

Additional Information

Authorized Official

Authorized Official Last Name:
LEE
Authorized Official First Name:
TAE
Authorized Official Middle Name:
SON
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
253-302-3826

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , with the licence number:  31130100 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: 31130100 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0405X , with the licence number: 31130100 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2096846 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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